Page 1 of 23 Student Name: Darlington Community 11630 Center Hill Road Darlington, W $3530 (608)776.20063 Plan Information Meeting Date: 10/23/2016 ‘Start Date: 17/02/2015 End Date: 10/22/2016 | Evaluation Date: 10/27/2014 ‘Special Ed Status: Yes ‘Special Ba Setting: Ages 6-21: inside the regular Classroom with ondisabled peers 80% or more of the time ‘Primary Disability: Hearing Impaitment ‘Secondary Disability: Visual Impairment Eval Adopted From: [Adopted Date: Plan Adopted From: ‘Adopted Date: ‘Student Information ‘Student Nam DOB: [Student Number: Address: -Distret of Residence: Darlington Community ‘School of Attendance: Darlington Elementary!Middle School | Grade: 97 Gender: Race (Ethni Code): Guardian Information ParentGuardian's Name [Work Phone (Gai Phone Email Rlatonship to Student Mother Seat dares, C Home Phone ParentoGvardian’s Name [Work Phone (Call Phone ~ Relationship to Stadent [Father Street Adress, City, State, Zip Home Phone IEP Meeting Participants “This Team Meeting was held at 01:30 PM on 10/28/2016 in/at ELL Classroom, Tie ‘Names of AN Team Member ‘Attn Mother Yes Yes InterpreterELL Teacher Lindstrom, Michelle Yes No Father Yes No | Educational Audiologist Richardson, Jenny [ves No FTeacher ofthe Deaf & Hard of McCarthy, Kelly Yes Yes Hearing [Orientation & Mobility Speciaist Wiliams, Cheryl Yes No [Case Manager Rose, Kelly Yes Yes LEADistict Payoh ‘Campbell, Nell Yes Yes Studant Yes Yes Teacher of the Visually Impaired Jerrard, Cortney Yes Yesrage 2 012 IEP Meeting Participants IntorpreterELL Teacher Crist, Kaleo Yes Yes [LEAISped Teacher Ritchie, Erin Yes No [Student Teacher Lange, Adar Yes Yes [7h Gr. Math Teacher Fitzsimons, Steve Yes Yes ‘Student Teacher Frat, Daren Yes Yesrage > 01 23 ‘oem sates District Cover Sheet (1-3) Purpose of Meeting: (check al hat apply) a (Evaluation including determination of eligibility Initial oF Annual IEP Development (1 P Review/Revision Develop a statement of wansition goals and services (required for students age 14 and older or ‘younger i appropriate) Ti) Placement CO Masitestation determination 1 Determine setting for services during disciplinary 1 Atterate Assessment change in placement DO otter: fa purpose ofthis meeting is /EP development, review, and/or revision related to the academic, developmental and Functional needs ofthe child, the IEP team considered the results of Initial or most recent evaluation Hl ves [Not Applicable ‘Statewide assessments ves [Not Applicable Districtwide assessments Bl ves 1 Not Applicable [fhe parent didnot attend or participate in the meeting by other means and did not agree tothe time and place ofthe IEP team meeting, document 3 efforss to involve the parents: “Teleohone conversation on Thursday. Seotember 2.2016 at 1:30 PM between Kalee Crist (ELL teacherfinterpreter) and (mother) to set up student) IEP meeting, “An IEP invitation for (student) IEP meeting was hand delivered to (student) on Monday, September 21, 2015 at 3:30 PM. “An IEP invitation was hand delivered by Kelly Rose (case manager) to" mother) about (student) IEP meeting on Monday, September 21, 2016 at 3:30 PM, *An IEP invitation for (father) was placed in the Darlington Elementary-Middlle Schoo! outgoing mail on Monday, September 21. 2015 at 3:30 PM by Kelly Rose (case manager) about: (student) IEP meeting. “Telephone conversation occurred on Thursday, October 22, 2015 at 8:30 AM between Kalee Crist (ELL teacherinterpreter) and (mother) to give a reminder about {student IEP meeting.rages on 29 ae te Present Level Of Academic Achievement and Functional Performance (I-4) WNote: Present level of academic achievement and functional performance must include information that corresponds with each annual goal Describe the student's strengths and the eoncems of the parents about the student's eduction, STRENGTHS:\ is a pleasant, cheerful, and easy-going student that enjoys working with both teachers and peers. He demonstrates compassion for others by offering his good sense of humor into conversations, also ‘shows interests in drawing and learning new facts or ideas that excite him, Ho exhibits a willingness to contnoute to class ciscussion where he can display his storytelling skils. When glven proper direction, Is willing to work hard on tasks that ere given to him. This demonstrates his willingness to work one on one with adults. In his free time, enjoys playing video games. PARENT CONCERNS: Mom expressed she was pleased thats demonstrating good behaviors in school ‘She mentioned that they have a deal at home. The deal is that __does not have to attend summer school if he ‘applies himself during the school year. Mom mentioned ithas been a struggle to get. to wear his glasses at home. They continue to work on good habits with occasional frustration, Mom expressed concerns about behaviors at home, Describe the student's present level of academic achievement and functional performance including how the student’ disability affects his ‘or her involvement and progress in the general education curriculum. For preschool children, desctibe how the disability affects involvement in age-appropriate activities. (Nore: Present level of performance must include information that corresponds with each annual goal) ACADEMIC PERFORMANCE: Gore Subject Grades as of Friday, October 16, 2015 at 3:30 PM: *Readingi/LA: 1st Quarter-B (87% *Mathematics: 1st Quarter-B- (81%) *Science: 1st Quarter-B (85%) *Social Studies: tst Quarter-B+ (68%) ReadingiL anguage Arts: During benchmark testing in October 2015, ested at a level M according to the Fountas and Pinnell Benchmarking System (no gains). “current Fountas and Pinnell Benchmark reading levels equivalent to an end of second grade reading level. The expacted soventh grade benchmark level is Z. Currently.” is choosing independent reading books that are more challenging than his guided reading level Therefore,! is struggling to accurately read all text and comprehend information. . During September 2015 MAP testing, _s eamed a reading RIT score of 186-4thvhtie (grade level norm is 214). Accommodations and ‘modifications necessary for to succeed in reading/lanquage arts include: extended time, adult assistance, preferential seating, frequently checking for understanding, homework and assessment modifications, and use of assistive technology (FM sysiem, magnifiers, etc.) Mathematics: has been working from a 7th grade mathematics curriculum in the general education setting Thus fer, has demonstrated the abilty to complete all assigned problems with 75-80% accuracy. Should the ‘content become too demanding andior time be limited, . assignments will be modified to include 50% of the problems on assignments, which will only graded upon completion. Dally adult assistanee, guidance, and correction ‘during study hall has aided in the completion of assignments, often tends to guess and shout out answers while working on assignments with adults without first using the skils presented in lessons. He receives classroom ‘Support during instruction and while completing seat work. Additional accommodations and modifications necessary for to succeed in mathematics include: extended timo, preferential seating, frequently checking for Understanding, assessment modifications, and use of assistive technology (FM system, magnifiers, etc.). During September 2015 MAP testing,’ earned a math RIT score of 218-33rd%atle (grade level norm is 223). Social Studios/Science: receives general education instruction in science and social studies. Currently, demonstrates the ability to complete and tur in 100% of assignments by their due date earning ‘approximately 85% on tasks in both science and social studies. Accommedations and modifications contributing to success in science and social studies includes: extended time, daily adult assistance, preferential seating, ‘requent checks for understanding, assessment modifications, and use of assistive technology (FM system, ‘magnifies, etc). He is also provided with daily notes. Daily notes and textbook sections are read aloud to” in ‘order to increase his comprehension of the content. Prior fo unit tests, is aiven a study guide focusing on the ‘material that he will be tested on. Currently, modifications are not made to ssignments. Should the content become too demanding and/or time be limited, “assignments will be modified to include fewer problems on assignments, which will only graded upon completion. FUNCTIONAL PERFORMANCE: Organization: This school year, 18 demonstrated more responsible organizational skills. With a single prompt, demonstrates the abilly to come prepared with necessary classroom materials (ex. writing utensils), older, notebook(s). textbook, independent reading book, assignment notebook, etc.) in atleast six out of elght classes daily. Additionally, _: has been observes filing out his assignment notebook andlor asking for adult assistant in filing out his assianment notebook. During study hall, usually requites one reminder to fil out his assignment notebook. -orrectl fils out his assignment notwoook in three out of five opportunities weekly,rages ui29 owes smn: + Present Level Of Academic Achievement and Functional Performance (I-4) Behavior: On occasion, rearing and vision difficulties result in off task behaviors (beat-boxing, wandering ‘eyes, lengthy peer conversations, fidgeting, sharing sill, off-task commonts, ot.), which impede not only his own learning, but also the leaming of peers around him, Additionally, enjoys discussing diferent video games. It is observed that itis diffcult to redirect to appropriate conversations and tasks when he is interested in discussing video games. In these circumstances, __s easily distracted, unable to regain focus/stay on task, ‘and demonstrates a resistance to participate/work. Strategies to assist in demonstrating on task behaviors include: verbal and physical redirection, prompting, checking for unerstanding, reteaching, and an individualized ‘study hall to assist him with missed work completion. Despite | __ occasional distracting behaviors, | ‘demonstrates a consistent posiive attitude toward peers, staff, school, and himself, Negative comments about himself and school have not been observed this school year, Though lisplays a pleasant altiude toward ‘school, he continues to struggle with self-advocacy skils. Staff members rarely observe asking questions \when unclear of directions and seldom observe volunteer appropriate, on-task answers to classroom questions and discussions, Hearing Aids/Glasses: It was determined on Wednesday, September 2, 2015 that one ol ering aids was ‘not working properly. Since then, ase manager (Kelly Rose) and distit interpreter (Kalee Crist) have been ‘working diligently to make appropriate contacts necessary tox hearing aid, An appointment was made for Thursday, October 1, 2018 tohave hearing aids examined and fixed. itis currently the recommendation to get" anewpair of hearina aids. hhad an appointment on Thursday, October 15, 2015 to fit him for a new pair of hearing aids. ‘now has @ hearing aid appointment schedule for November &, 2015. Therefore, there is no data gathered about willingness and responsibilly to wear his hearing aids at this ime, Based on ‘observations and charting, brings his glasses to school in four out of five days. does not require prompting to wear his glasses on these days. On the days that forgets his glasses, he is responsible about finding the protective eyewear in his locker. is more reluctant to wear the protective eyewear. He requires {wo to four prompts per class period to wear the protective eyewear over his eyes as he has the tendency to simply rest them on his head. is responsible abou! locating and wearing his protective eyewear during recess and Physical education. Before and after recess, __: consistentlv exchanges hs seeing glasses and his protective ‘eyewear in his locker. Before and after physical education, __onsistently exchanges his seeing glasses and his protective eyewear in his physical education locker. He does not require prompting for these behaviors. AUDIOLOGY: ‘The following is 2 review of the available audiometric records for was seen on March 7, 2014 “most current audiogram on fle is from 3.7.14 at Memorial Hospital in Darlington. Hearing thresholds have fluctuated some since his last evaluation in 2012. Lower frequencies improved some, but higher frequency thresholds got stightly worse. Hearing thresholds indicate mild sensorineural hearing loss sloping to severe in the right ear. Responses for the right ear were as folios: 15/20/25/45/75/85dB HL at 250/500/1000/200014000/8000 Hz. Thresholds for the left ear indicate a mild sloping to a profound mixed hearing loss. Responses for the left ear ‘were as follows: 30/30/45/100/105/60dB HL at 250/500/1000/2000/4000/8000 Hz. ‘Word recognition scores are as follows: Right ear 9%, Left ear 76%. The lower score forthe left ear maybe due to discrimination abilties ofthe lft ear. * has behind:the-ear hearing aids, bilaterally (Phonak Nios Micro Ill). He was it with hearing aids in AprilMay 2010 when his hearing loss was identified. Currently one of hearing aid is not working properly and is being fixed. He is not wearing the other hearing aid as he reports its too confusing. He Is not the fist chi to state this so tilthe other is fixed, he is not wearing any amplification. ‘His mother reports normal neworn/infant hearing screening and CT scan was considered normalin May 2010, *Re-occurring wax removal needed every 6 months, “AL this time, records indicate no known cause for hearing los, “According to his mother, he had tubes put in hs left ear in June 2012. + “was fit with a personal FM system in the fall of 2012, He is able to identify a problem with his hearing aid or FM about 75% of the time. He is independently carrying the teachers’ microphone from class to class. His ‘complaints of his earmolds hurting have decreased in the last two years. Ho is able to insert and remove his, fearmolds properly He uses his FM most freauenily when staff reminds him to use i. needs strong guidance fon his use or he willnot initiate use. With being visually impaired and hearing impaired, itis imperative that he ears his hearing aids and FM system, “Functional listening assessment revealed that when background noise was present _scorada 100% when Uutiizing the FM system. However, when the FM was not used his scored dropped to @ 60%. HEARING: In October of 2015, had forgotten the parts of the ear and was guessing as to which part was the inner ear ‘and the names of the bones in the ear. He knew the cochlea but also circled the semicircular canals as part of the cochlea. When asked what he could do to help himself understand the teacher in the classroom, __was able to namo 1 ‘out of 6 strategies that he could use (17%). Thal strategy was speechreading. When given subile clues, he was able to add three more strateges increasing his score to 4 out of 6 (67). Speechreading: In the past when speech reading has been worked on more, _had been successful with up to 667% accuracy on known words and sentences. After the summer when checked in October of 2015, he was able to repeat simple sentences at 50% accuracy,rageomes onmwem samme: Present Level Of Academic Achievement and Functional Performance (1-4) ‘Aucitory Skis: Comprehension of auditory information is important for ___ Given a simple paragraph, as able to answer questions about the paragraph read to him orally with 60 % accuracy. Vision: 1as an eye condition called glaucoma (high pressure in his eyes) and only light perception in his left eye, The visual acuity of his right eye is 20/30 and he wears protective glasses. Because he has no usable vision in his left ‘eye, he has a significant visual fold loss on his left side. This, combined with hearing better out of his right ear, ‘makes it best for him to sit on the loft sido of the room in order to allow him to hear and see more information from his right side, uses magnifiers any time something is too small for him to read. He has access to a CCTV, although he rarely uses it due to its location and because the magnifies typically work better for him. has access to an iPad, but there is room for exploration of ts uses (bookshare, joinme, etc). _ is able to doscribe his vision loss and how it affects him in school does not bring his magnifiers everywhere with him, however he is proficient with using them, In addition to practicing visual efficiency strategies, 8 working on most areas of the Expanded Core Curriculum (specifically designed areas of study that require extra instruction or attention for children with visual impairments). ORIENTATION/MOBILITY: 1. Will demonstrate safe & effective cane skills (shore-tining, slide technique or 2 point touch). Update: has {great cane technique and is accurate when using them with or without a blindfold. He maintains technique throughout his lessons. 2. Will demonstrate correct use of monocular to locate visual targets 6/6 occurrences. Update as had the ‘opportunity to use a 6x monocular and was able to locate all requested targets in very short time. He has good technique, IMPACT: ‘hearing and vision disabilities affect his academic focus, performance, and organization, which in {urn affects his ability to gain information from iterary and informational texts. This impacts all academic areas. His hearing and vision disabilites also impact his auditory processing and auditory memory where he has difficulty processing problems and remembering information presented orally. Ths impacts his ability to follow multi-step directions, comprehension, and recalling complex concepis, Luditory processing and memory also impacts his academic success in all instructional settings in regard to oral presentations, reading, written language, math, and to a lesser degree, science and social studies, Will the student be involved fulltime inthe general education curriculum or, for preschoolers, in age-appropriate activities? Byer (No (fn, describe the extent to which the student will not be involved full-sime in the general curiculum or, for preschoolers, tn sge-appropriate activites) Special Factors After consideration for special factors (bebavior, limited English proficiency, Braille needs, communication needs including deatThard of hearing, and assistive technology), is there a need in any ofthe areas? Please refer to -5: Special Factors. Bl Yes No Afyesar the student has a visual impairment, complete the I Special Factors page)eps sues ‘emcees Special Factors (1-5) Note: Fow any neg) idnfified belo, ther mst be a statement of the service(s) to mec that ned Gnclng ancuntfequency location and duration) on the Program Summary page (1-9). - is A. Does the student's behavior impede his/her leaming or that of others? Yes [No Please include the postive behavioral inerventions, strategles, and supports to address thar behavior: (On occasion, hearing and vision difficulties result in off task behaviors (beat-boxing, wandering eyes. peer ‘conversations, fidgeting. ele.) which impede not only his own learning, but also the leaming of pears’ around him, In these circumstances, is easily distracted, unable to regain focus/stay on task, and demonstrates a resistance to participate/work. Strategies to assist ‘demonstrating on task behaviors include: verbal and physical recirection, prompting, checking for understanding, reteaching, and an individualized study hallo assist him with ‘missed work completion. BB Is the student a student with limited English proficiency”? Yeo [] No Please include the language needs that relate wo this TEP: ‘speaks both English and Spanish. He currently rocoives ELL services from the ELL teacher(s) . If visually impaired, does the student need instruction in Braille or the use of Braille? D ves Li Cannot be determined a this ime 1 Nor Applicable Wes, include Braille needs; no or cannot be determined, attach ER-3 from the latest evaluation reevaluation ‘Though struggles with vision, orientation, and mobility, he doos not yet demonstrate the need for Braille andlor Braille instruction, D. Does the student have communication needs that could impede his/her learning? GI Yes [1] No Ifo, include communication nerds, yes and ih sede s deaf or hard of hearing. de he communicton needs Tee heat tang: ee a to tthe det eng and common node ad scademeYreand ll range neds ine helngopecreane fo acct hearing thresholds indicate mild sensorineural hearing loss sloping to moverate in the right ear and a moderate stoping to a profound med hearng lass or hele ear, Acitonaly, Teen oss makes i ffcull forhim to hoar varus components of speoch-This would be eapoctl tue wien background meses presen order foassist """ inblaning infomation he has acess tos vaney of ascivetoctnlogy at ncses, but a tot Inited to: a personal PM ystm, FM sycim touble shooting. unconelaesossmont of EAI systems within te choo! environment, sending infor PM system exuipment and ropa (whl bing proved wih oar FM system), end summer mainenance ot FM stm (while being provides wha lost PM syste) has been diagnosed with conaenital glaucoma, along with a surface band keratopathy of his left eye, leaving ‘only ight perception. Because has no usable vision in his Ieft eye, he has a significant visual fied loss on his left side, He wears glasses to protect his eyes at all times. In order for him to access materials visually, they should be presented on his right side. Because __hears better out of his right ear, itis best for him to sit on the left side (of the room (from his prospective when looking towards the front ofthe room). This wil alow him to hear and see ‘more information from him right side, ‘as recently begun using dome magnifiers and has been intraduced to a CCTV in school. The magnifiars have made a significant difference in his ability to access reading materials and he immediately grasped the technique for using them. E, Does the student need assistive technology services or devices? ye [No Please specify particular device(s) and service(s) Uses a variety of assistive technology that includes, but is nol limited to: a monocular, a cane, various. ‘magnifiers, a personal FM system, CCTV, a SMARTboard, an iPad and applications, a calculator, a spel-chacker, an electronic reader (nook, etc.) and recordings, a Chromebook, a laptopicomputer, and other word processing devices. also needs access to assistive technology services that includes, but is not limited to: FM system trouble-shooting, functional assessment of FM system within the school environment, sending in for FM system ‘equipment and repairs (while being provided with a loaner FM system), and summer maintenance of FM system {while being provided with a loaner FM system).‘Annual Goals and Objectives (I-6) Measurable annual academic or functional goals to enable the child tobe involved in an progress in the general education curriculum, and to meet ‘other educational needs tat result from the disability eee eee (ote: present levels of academic achievement and fanetional performance must include information that corresponds with each annual goal) Goals Will explore at least 3 different strategies or devices that allow him to be more efficient when accessing ‘school materials. Benchmarks: 4) will use apps and functions on the iPad to access the curriculum and homework, 2) will use the CCTV and magnifiers to increase his efficiency with reading, 3). will advocate for other strategies or devices that will assist him with completing his work. Baseline: has an iPad at school but has not used i this year. He has used magnifies this year, but not the CCTV or other strategies or devices. Procedures for measuring the student's progress toward the annual goal: -observations notes ‘Will annual goal (including benchmarks or short-term objectives) be addressed during ESY? O ys DB No Note: When revies ing goals, use the Progress Report Form to make periodie comments and assessments, ‘Will the student participate in an alternate assessment aligned with altemate achievement standards fr students with disabilities in any subject area? O ye @ Ne (Ayes. include benchmarks or short-term objectives for the student) ‘When wit! eports about the studem's progress toward meeting the annual goal be provided to parents? Quarterly Goal #2 will ndependently identity new vocabulary torms and utiize reading comprehension strategies to answer ‘questions for a level Q tex! (according to the Fountas and Pinnell Benchmarking System). Procedures for measuring the student's progress toward the annual goal: teacher observation -gradebook (Infinite Campus) -Fountas and Pinnell Benchmarking Systom ‘Will annual goal (including benchmarks oF short-term objectives) be addressed during ESV? O Ye Ne "Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments. Will the student paticipate in an altemate assessment aligned with alter achievement standards fr students with disabilities in any subject arca? DO vs f No (yes, include Benchmarks or short-term objectives forthe student) ‘When will reports about the student's progress toward mecting the annual goal be provided to parents? Quarterly Goat #3 With a single adult reminder, ‘il demonstrate preparedness for class (bringing a correctly filed out assignment notebook, bringing all necessary materials, completed assignments, etc.) daily in seven out of eight ‘opportunites. Procedures for measuring the student's progress toward the annual goal: teacher observation daily classroom preparedness chartingAnnual Goals and Objectives (I-6) ‘Will annval goal (including benchmarks oF shor-term objectives) be addressed during ESY? O yes f No [Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments, ‘Will the student paticipate in an alternate assessment aligned with altermate achievement standards for students with disabilities in any subject DO ys f No (ves, include benchmarks or shor-term objectives for the student) ‘When will reports about the students progress toward meeting the annual gol be provided to parents? ‘Quarterly Goal #4 will demonstrate on-task behaviors (eye-contact, participating, not fidgeting, etc.) during instructional and independent work times with no more than three prompts from an adult per class period, Procedures for measuring the student's progress toward the annual goal: leacher observations -teacher on-task behavior charting snark or short-term objectives) be addressed during ESY? Willan O ys No ‘Note: When reviewing goals, use the Progress Report Form fo make periodic comments and assessments. Will the student participate in sn alternate assessment aligned with altemate achievement standards for students with disabilities in any subject Dyes (Aves, include benchmarks or shor-term objectives for the student) val goal (including ben No ‘When will reports about the studen’s progress toward meeting the annual goal be provided to parents? Quarterly Goal #5 sill se-advocate when he is unclear of directions andior tasks in three out of four opportunities dally. Procedures for measuring the student's progress toward the annual goal: teacher observation teacher self-advocacy behavior charting Will annual goal (including benchmarks or short-term objectives) be addressed during ESY? O ys fH No Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments. Will the student participate in an alternate assessment aligned with altemate achievement standards for students with disabilities in any subject O ys @ No (Ayes, include benchmarks or short-term objectives for the student) ‘When will eports about the student's progress toward meeting the annual gol be provided to parents? Quarterly Goal #6 will continue to improve his orientation and mobility sklls by completing a minimum of 5 out ofthe 6 benchmarks listed below. 1. __willutlize @ map to accurately plan Lroutes & Z-routes from intersection to intersection, a minimum of 4 out of 5 trials. 2. nil safely and accurately travel his plannod route to reach his destination with the assist of his map, & ‘minum of 4 out of 5 tals.rage 10 een sue Annual Goals and Objectives (I-6) 3. ___ will plan and safely, accurately and independently travel a return route to his staring point, a minimum of 4 out of 5 trials 4 will uliize the address system to locate given destinations, 4 out of § tals, 5 ‘ill safely and independently cross at intersections controlled by traffic lights, 100% ofthe time. 6 will safely and independently cross at traffic lights with turn arrows, 100% of the time. Procedures for measuring the student's progress toward the annual goat: teacher observation anecdotal charting and data Will annul goa (including benchmarks or short-term objectives) be addressed during ESY? O Ye Nm Note: When reviewing goals, use the Progress Report Form fo make periodie comments and assessments, Will the student participate in an alternate assessment a area? O ve Nm (ayes, include benchmarks or short-term objectives for the student) with altemate achievement standards for students with disabilities in ny subject ‘When will reports about the student's progress toward meeting the annual gol be provided to parents? Quarterly Goal #7 «nil show evidence of knowledge and skill related to his hearing loss in the folowing areas: Continuing to wear hearing aids at school except during wet activities with 95% accuracy Hearing aids functioning property at school 95% of times observed -When amplification devices are not working, wil rouble shoot the problems and then ask a staff person to call or email for assistance 95% of times observed Procedures for measuring the stadon’s progress toward the anaual goal: ‘observation of DHH teacher and schoo! staff, anecdotal data, and charting Will annual goa (including benchmarks or short-term objectives) be addressed during ESY? O Ye Ne Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments. Will tne student participate in an alternate assessment aligned with aliemate achievement standards for students with disabilities in any subject sex? O Ys (yes, include benchmarks or short-term objectives for de sudens) ‘When wil reports about the student’ progress toward meeting the annval goal be provide to parents? Quarterly Goal #8 will state strategies to be used to compensate for his hearing loss, The strategies used may include but are not limited to: Asking for clarification or repetition of information spoken Let others know when he is not able to hear Asking to move to a quieter place or fora door to be closed. Asking o place himsetf in the classroom so that he can see and heer the person speaking Using speechreading to understand spoken information _ wil be able to repeat 80% of the strategies discussed, Procedures for measuring the student's progress toward the annual goal: observation of DHH teacher and school staff, anecdotal data, and charting Will annual goal (including benchmarks or short-term objectives) be addressed during ESY? O ve f wo "Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments.rings 44 on 29 wea seat ‘Annual Goais and Objectives (I-6) ‘Will the stent participate in an alismate assessment aligned with aliemate achiovement standards for stodents with disabilities in any subjoct O Ys GB No (ves, include benchmarks or shor-term objectives for the student) ‘Whea will reports about the student's progress toward meeting the annual goal be provided to parents? Quarter Goal #9 will speechread familar sentences with 80% accuracy and speechread unfamiliar sentence with 50% accuracy. Procedures for measuring the student's progress toward the annual goal observation of DHH teacher and schoo! staff, anecdotal data, and charting ‘Will annual goal (including benchmarks or shor-term objectives) be addressed during ESY? Oye No "Note: When reviewing goals, use the Progress Report Form to make periodie comments and assessments. Will the student participate in an alternate assessment aligned with aliemate achievement standards for students with disabilities in any subject area? O Ys No (ves, include benchmarks or short-term objectives for the student) ‘When will reports about the student's progress toward meeting the annual goal be provided to parents? Quarterly Goal #10 When a 3 to 5 sentence paragraph is read to he wil be able to repeat 5 details or answer 5 questions about the passage with 85% accuracy. Procedures for measuring the student's progress toward the annual goal observation of DHH teacher and schoo! staff, anecdotal data, and charting Will annual gol (including benchmarks oF short-term objectives) be addressed during ESY? O vs No Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments. Will the student participate in an alternate assessment aligned with alternate achievement standards for students wih disabilities in any subject OG Ys Ne (Aves, include benchmarks or shor-term objectives for the suudent) ‘When will eports about the student's progress toward meeting the annual goal be provided to parents? QuarterlyDistrict-Wide Assessment (|-7) C1 District-wide assessments not given OR 1 Student will nt be inthe grade when a distrit-wide assessment is given OR District-wide assessments given List distrct-wide assessment(s) student will take: -MAP Testing (Reading and Mathematics) in Winter "18, Spring "16, and Fall "6 -Fountas and Pinnell Benchmarking in Fall'"5 and Spring 16 Yes [J No Thestiden needs testing accommotions (peas) -MAP Testing: -math (entre test read aloud) and reading (only directions read aloud) math assessment taken in @ one-on-one environment with minimal clstractions “use of FM system “ext enlarged on computer screen extended time -short movement breaks as nooded -Fountas and Pinnell Benchmarking: assessment administered in a one-one-one environment with minimal distractions “use of FM system xt enlarged (magnifier) CO Yes [5] No ‘The stadent will participate in an alternate assessment ™ (the I-7-A Participation Guidelines for Alternate Assessments must be included with thelEP).‘Access for ELLs/Alt. Access for ELLs (-7) ‘According to Title II of the No Child Left Behind Act of 2001 section 3113 (63D) all Linsited English ProficientEnglish Learner (LEP/EL) students are required to take annually a language assessment inal four language domains of reading, writing, speaking and listening regardless of isability stats, Individualized Education Program (IEP) teams are required to decide annuslly whether students who are classified as LEP/EL and ‘who have a disability will participate in (1) the ACCESS for ELLs® with or without accommodations, or (2) the Altemate ACCESS for ELLs™ \with or without accommodations. ‘Accommodations for the ACCESS for ELLs® or Alternate ACCESS for ELLs™ are specie to these assessments, Please check the Office of Student Assessment website forthe current accommodation polices. Complete "I" OR “2” [E]__ 1. The student will take the ACCESS for ELLs®. For students taking the ACCESS for ELS, complete all four assessment and secommodations chats, below. Note: ACCESS for ELLs is available for students in grades kindergarten through I Speaking ACCESS fer ELLs TE] ACCESS for ELLs with accommodations in the language domain of ‘without aecommadations in speaking. dish the language domain of entire test read aloud (Including repeating) speaking -{est taken in a one-on-one setting with minimal distractions extended time ifnot completed inthe time allotted text enlarged with magnifier -short movement breaks if necessary “use of FM system Listening TD ACCESS tor ELLe® TE] ACCESS for ELLs with accommodations in the language domain of sxithout accommodations in listening. dist the language domain of entire test read aloud (including repeating) Tistening, ~fest taken in a one-on-one setting with minimal cistractions extended time if not completed in the time alloted text enlarged with magnifier -short movement breaks ifnecessary suse of FM system Reading (ACCESS for ELLs TH) ACCESS for ELLs® with accommodations in the language domain of ‘without accommodations in reading. (list the language domain of only directions read aloue (Including repeating) reading, -{est taken in a one-on-one setting with minimal distractions extended time if not completed in the time allotted -text enlarged with magnifier “short movement breaks if necessary ‘use of FM system ‘Writing 1] ACCESS for ELLe® [E]__ ACCESS for ELLs with accommodations in the language domain of ‘without accommodations in ‘writing. is: the language domain of entire test read aloud (Including repeating) writing. -fest taken in a one-on-one setting with minimal distractions -extenided time if not completed in the time allotted xt enlarged with magnifier -short movement breaks if necessary “use of FM system Any stional considerations: oR [)__2.The student will ake the Alternate ACCESS for ELLS™€ (he I-7-A Pariilpation Guidelines for Alternate Assessments must be included with the IEP). For students taking the Altemate ACCESS for ELLs™, complete all four assessment and accommodations chars below. Note: Alternate ACCESS for ELLs™ is available for students in grades I-12 onlyage 1 un 09 ‘Access for ELLsiAlt. Access for ELLs (-7) Speaking ‘Alieriate ACCESS for ELLS™ without accommodations inthe Tanguage domain of speaking, a ‘Alierate ACCESS for ELLS® with accommodations inthe language domain of speaking, dish Listening ‘Altemate ACCESS for ELLs™ without accommodations inthe Tanguage domain of listening, ‘Altemate ACCESS for ELLs® with accommodations in the langwage domain of listening. (is) Reading ‘Allernate ACCESS for ELLs™ without socommodations inthe language domain of reading ‘Alternate ACCESS for ELLS® with accommodations inthe language domain of reading. isd: ‘Writing “Alfemate ACCESS for ELLs™ without accommodations inthe language domain of vwniting. ‘Altemate ACCESS for ELLS® with accommodations inthe language domain of writing. (is Any addtional considerations:rage wou eee same: State-Wide Assessmer BA (1-7-SBA) ‘The student will bein Ose Om Osmn Dom Bm 0 an ‘rade when the Smarter Balanced Assessment (SBA) is given in English language arts (ELA) and Mathematics. The stadent willbe taking general ‘education assessments fr all content areas required a this grade level SBA has specific policies and guidance elated Universal Tools, Designated Supports and Accommodations permitted on the assessments in ELA and Mathematics. Please refer to the Office of Student Assessment website forthe curent polices. Section A: Universal tools and designated supports Universal Tools are available to all students for computer administered SBA assessments, although an IEP tears may determine that one or more ‘might be distracting fora particular student and thus the sehool must “turn-off the feature forthe student, Please list any Universal Tools that should be ‘tumed-off for the student: The following Universal Toots should be turned off: masking, stike-through, and color contrast. Designated Supports are also available for any student for whom the need has been indicated, Pease list eny Designated Supports that may be requited forthe student atthe time of testing: {ests and directions read aloud with option of repeating fests taken in a small group setting with minimal distractions enlarged text (zoom, magnifior tool, font size) use of FM system (connected to computer audio) “movement breaks “extended time Section B: Accommodations (complete both charts) HA T EeAsiiion | [i] ELA. accommodations dan: decorations ‘onl destons read aloud nclucng repeating) “Tel taken in small group sting est taken in a quel environment wth minimal distractions “enlarged tent (200m magne ool fot 20) -use of FM system (connected to computer audio) “movement broke needed ended ime i not completed in the tie alloted ‘Matberatios T]_ Mathematies TX] Mathematies with accommodations ish: without directions and entire tost read aloud (Including repeating) accommodations fest taken in small group setting test taken in a quiel environment with minimal distractions enlarged text (zoom, magnifier tool, font size) uso of FM system (connected to computer audio) movement breaks if nsoded extended time if not completed in the time allotted "General Assessments in Wisconsin refer to content reflective ofthe Common Core State Standards and the Wisconsin Model Academic ‘Standards. These assessments include the Wisconsin Knowledge and Concepts Examination, Smarer Balanced Assessment, ACT Aspite™ Early High School, ACT WorkKeys and The ACT Plus Writing®.rage 11 un 23 Program Summary (1-9) Projected begianing and ending date(s) of IEP services and modifications: 1/02/2015 to 122.2016 Physical Education: EH Regular 1 Speciatly Designed ‘Voeational Education: Regular Specialy Designed Environment (The student wil participate full-time with non-lsabled peers ina regular education clases, [Z)_The student will not participate falsime with non-disabled peers in regular education classes, or for preschoolers, in ‘age-appropriate settings. (IT you have indicated a location other than regular education classes or age-appropriate sotings in the case ofa preschooler in I, or Tl above, you must check this box and explain why fulltime participation with non-disabled peers ‘snot appropriate.) Due to his aucitory and visual impairments, _wilbe removed from the regular educational environment to ‘work one-on-one with each ofthe following specialized service individuals: an educational audiologist, teacher of the deaf and hard of hearing, teacher of the visually impaired, and an orientation and mobility specialist. These specialized services would be inoffectve i provided in the regular education environment. ull also be placed in an individualized, smal! group study hall in the special education environment to assist him with focus, organization, and task completion. Extracurricular and Non-academle Activities Will the student be able to participate in extracurricular and non-academic activites with non-disabled students? B ys OQ wo (no, describe the extent to which the student will not be involved in extracurricular and non-academic activities with non-disabled students) ‘Special Education Services (1-9) ‘Special Education Services Service Frequeney/Amount Tocatio Duration ESY Provider __(directindireet min) ‘SupportediResource Study Hall LOICross Cat —_(45.0/0.0) Special svozz015- Teacher minutes 1.0 Education 1012/2016 times per day Environment Comments: For the duration of the IEP, "ll receive a minimum of one 45 minute study hall per day. At the discretion of the case manager andlor parents, willbe able to receive a maximum of two 45 minutes study halls per day. ‘Visual Impairment Support LDICross Cat (60.0/0.0) Regularand = 11/02/2015- Teacher minutes 1.0 Special 10/22/2016 times per month Education Environments ‘Comments: For the duration of the IEP, _will work one-on-one withthe Teacher of the Visually Impaired Students, ‘Other (See Comments) LDICross Cat Panny Regularand —11/02/2015- Teacher minutes 2.0 Special 1012212016 times per month Education Envrironments Comments: For the duration of the IEP, ill work one-on-one with the Teacher of the Deaf and Hard of Hearing Students, Reading/Lang. Arts Instruction LDICross Cat —_ (0.0/0.0) Regular = 11022015-. Teacher minutes 1.0 Education 10/22/2016 times per day Environmentsrage 10.0142 ee sae Related Services (1-9) Related Services needed to benefit from Service Frequeney/Amount Tacation Duration ESY special education including frequency, Provider (directindireet min) Tocation, and duration Gf different from TEP beginning and ending dates) Audiology ‘Audiology (60.000) Rogular and 1vozeo6- minutes 4.0 Special 10/22/2016 times per year Education Environments Comments: For the duration of the IEP, will work one-on-one with the Educational Ausiologst Orientation & Mobility LD/Cross Cat (60.0/0.0) Regularand = 1102/2015- Teacher, minutes 2.0 Special 1072212016 times per month Education Environments Comments: For the duration ofthe IEP," will work one-on-one with the Orientation and Mobility Specials. ‘Supplementary Aids and Services (I-9) ‘Supplementary Aids and Services aids, Service Frequeney/Amount Location Duration ESY services, and other supports provided to or ‘Provider _—_(direcUindirect min) u behaif ofthe student in regular education ‘or other educational settings. Other (See Comments) LDICross Cat (0.0/0.0) minutes Reguiarand = 11/02/2015- Teacher —-0.0times per Special 1022/2016 ay Education Environments, Duration, Frequency, and Location: TESTING ACCOMMODATIONS/MODIFICATIONS: ervice is not tracked in directindirect tes or standard frequency options) 1), For the remainder of the IEP, vill receive a study guide for all quizzes and tests in all classes. Study guides must include questions and answers directly related to the unit guide. 2). For the duration of the IEP and in all classes, __will be provided with quizzes and tests that include: no more than three choices for multiple-choice questions (maximum of 15 questions), lsting answers will tke the place of short answer responses (maximum of 5 questions), a word bank for fil-in-the-biank questions (maximum of 10 questions), and a maximum of 10 matching questions. The fil-in-the-blank questions and matching questions will be chunked into sets of 5, will also dictate answers to an adult for essay questions. will use a ‘word-processing device to complete essays graded upon conventions. 3).For the duration ofthe IEP, _will have quizzes and tests read aloud to him in a quiet, small group ‘environment free of distractions or noises forall quizzes and tests in all classes. 4), For the duration of the IEP,!__will receive extended time (no more than two sequential school days) to ‘complete all projects, quizzes, and tests if uncompleted in the time allotod in all classes. This does nat include daily work/assignments, ‘Other (See Comments) LD/Cross Cat (0.0/0.0) minutes Regularand = 11/02/2015- Teacher 0.0 times per Special 10/22/2076 day Education Environments ifservice s not tracked in Duration, Frequency, and Locatio indirect minutes or standard frequency options) For the duration of the IEP, _will use his assignment notebook to keep track of and prioritize all daily assignments for classes, Preferential seating LDICross Cat Manne Regularand = 11/02/2015- [1] Teacher minutes 8.0 Special 10/22/2016 times per day Education Environmentspaves ec yates ‘Supplementary Aids and Services (I-8) Supplementary Aids and Services - aids, Service Frequency/Amount Loca Duration ESY services, and other supports provided to or Provider -—_(airec/indirect min) ‘on behaif ofthe student in regular educa {or other educational settings. Duration, Frequency, and Location: (if service isnot tracked in directindirect minutes or standard frequeney options) For the duration of the IEP, ___will bo seated so that his right ear and right eye are directed towards the teacher(s) and student(s) and placed in middle ofthe row due to no vision in his eft eye. wl algo be given flexible seating or billy to move to alacation in which he ean see and hear more clear Other (See Comments) LOIGross Gat (0.0/0.0) minutes Regular and 11/02i2018- Teacher 0.0 times per Special 10/22/2016 aay Education Environments uration, Frequency, and Location: (if service is not tracked in directlindirest minutes or standard frequency options) For the duration of the IEP, __ll use protective eyewear for all physical activity (recess, Physical Education, tc.) throughout the entire School day. will also wesr protective eyewear when glasses are nat at schoo. Note outines for note-taking during —-LD/Gross Cat _ (0.0/0.0) minutes Reguer —110272015- lectures Teacher 0.0 times per Education 10/22/2016 cay Environmonts Duration, Frequency, and Location: if service isnot tracked in directindirect minutes or standard frequency options) For the duration of the IEP, ___will receive a hardcopy ofall notes expected to be taken inside and outside of lass in all lasses. Al noies willbe enlarged. Keywords can be whited-out (not more than 10 keywords) for any notes to be taken during classtime. Other (See Comments) LD/Cross Cat (0.0/0.0) minutes Regularand — 1170272015- Teacher —_0.0times per Special 10/22/2016 say Education Environments Duration, Frequency, and Location if service isnot tracked in directindireet minutes or standard frequency options) For the duration of the EP, _willuso magnified visual trackers andlor other magnifier to read andior write (independently oF fllow-along) in ll classes. Modifications LDICross Cat _ (0.0/0.0) minutes Regular 1ozi2016 - Teacher —__-0.0times per Education 10/22/2016 ay Environmentsreponse oem ses ‘Supplementary Aids and Services (I-9) Supplementary Aids and Serviees- aids, Service Frequency/Amount Location Durati 1s services, and other supports provided to or Provider _(directindireet min) ‘on behalf ofthe student in regular education or other educational settings. Duration, Frequency, and Location: (if service is nat tracked in diectindirect minutes or standard frequency options) FOR THE DURATION OF THEIEP, "NIL HAVE THE FOLLOWING ASSIGNMENT ACCOMMODATIONS: Reading/Language Arts: -all assignments will be enlarged or used with magnifers, -all readings, questions, and directions willbe read aloud te ashe follows along (with the exception of work designated as independent) -all in-class assignments will be reduced “lengthy answers and writing assignments willbe dictated by to an adult for the adult to write down willbe graded upon what is completed during the school day/Homework Club Mat -all assignments will be enlarged via magnifiers andior online textbook “all directions and word problems will be read aloud tc “lengthy answers will be dictated by > an adult for the adult to write down, -assignments willbe reduced by 50% and graded upon accordingly Social Studies: -all textbook information, readings, questions, and directions willbe read aloud to as he follows slong -allin-class assignments will be reduced “lengthy answers and writing assignments willbe dictated by __0 an adult forthe adult to write down willbe graded upon what is completed during the school day/Homework Club Science: -all textbook information, readings, questions, and directions willbe read aloud to as he follows along -all in-class assignments willbe reduced -lenathy answers and writing assignments willbe dictated by ___ to an adult forthe adult to write down «rll be graded upon what is completed during the school day/Homework Club Electives: = ‘will not be given work to be completed outside of classtime Specials: -all assignments enlarged -all assignments graded upon what is completed during classtime -lenathy answers and writing assignments willbe dictated by to an adult forthe adult to write down vill not be given work to be completed outside of casstime Other (See Comments) Lo/Cross Cat _ (0.0/0.0) minutes Reguiarand §— 11022018- Teacher» 0.0imes per ‘Special 1072212016 day Education Environments Duration, Frequency, and Location: if service is not tracked in direc/indirect minutes or standard frequency options) For the duration of the IEP, and in the best interests of :ducation, staff members should use the following strategies: allow additional time for processing auditory information before requitng a response repeat answersiquestions of other students sc. an hear them through the FM transmiterimicrophone, ‘face iuring classroom instruction -repeat directions “use of physical contact and gestures to gain sttenton for instruction and transitions frequently check for understanding -attempt to control background noise (pencil sharpener, classroom chatter, etc.) during instructional times Classroom Support LDICross Cat (45.070.0) Regular suoz2e16- Teacher minutes 5.0 Education 10/22/2016 times per day Environments, Duration, Frequency, and Location: (if service is not tracked in direcfindirect minutes or standard frequency options) For the duration ofthe IEP, ill receive classroom suppor from an adult (ether a special education teacher (Fa paraprofessional) daily in science (45 minutes), social studios (46 minutes), roading (46 minutes), language arts (45 minutes), and math (45 minutes).Hu Modifications and Support Ser Program Modifications and Supports - for Service Frequeney/Amon Tocation Duration ESY school personnel that will be provided Provider ___ (directindireet min) Training Audiology (30.0/0.0) Regularand = 11/02/2015- minutes 1.0 Special 1022/2016 times per year Exueaton Environments Duration, Frequency, and Loct Om: (if service isnot tracked in directiindireet minutes or standard frequency options) A the beginning of the academic school year, there will be a staff training held to explain and discuss hearing impairment, FM system, and needs. Consultation LDICross Cat —_(15.0/0.0) Reguiarand §—110222015- Teacher minutes 4.0 Special 10/22/2016 times per year Education Environments Duration, Frequency, and Location: (Itservice is not tracked in directindirect minutes or standard frequency options) For the duration ofthe IEP, the case manager will consult with the educational audiologist, the teacher of the deaf {and hard of hearing, the teacher of the visually impaired, and the orientation and mobility specialist to discuss reeds, modifications, and progress. Collaboration LD/Cross Cat (15.0/0.0) Regularand = 11/02/2015- Teacher minutes 1.0 ‘Special ‘0122/2016 times per month Education Environments Duration, Frequency, and Location: (i service is not tracked in direclindirect minutes or standard frequency options) For the duration of the IEP, the case manager will collaborate withthe regular education staff and special education sa to discuss ods, modifications, and progress.rege 02 0149 oveuens eater Extended School Year (I-11) ‘Does the child require extended school year (esy) services to receive a fre and appropriate public education (FAPE)? Oye no, explain the reasons rejected No snrently demonstrates the ability to continuously make academic gains without significant regression.Determination and Notice of Placement (P-2) Darlington Community SCHOOL DISTRICT | Uyou need this notice ina different language or communicated ina differom way, or have questions about this notice, please contact Denise Wott at __(608)776-2006x3 Date of the placement termination: 1012312015 Date parent provided with notice of placement: +013012015 Doar ‘The IEP devsloped on 1029/2015 vill beimplemented at ___ Dartington Elamentaryiddle School inthe ton Community/Darlington School DisrcCity, with a projected date of implementation on a ozi2018 Wile child tend he schol hte woud alten if on dsb? Ys [No (ra, explain List other options considered, ifany, related tothe placement site (schocl building or school district), frequency, location, and duration ofthe special education and related services, supplementary ads and services, program modifications and supports, andthe place of those services that ‘ere considered. List the reason(s) rejected, and a deseripion of any other factors relevant t the proposed action BF None LB) You previously received a copy of your child's evaluation report and copy of his/her TEP is enclose. 1 Acopy of your child's evaluation report andthe LEP are enclosed, You and your child have protection under the procedural safeguards (rights) of special education law, The school distct must provide you with a copy of your procedural safeguards once a year. Previously you received a copy of Your procedural safeguard rights in a brochure about parent and child rights. If you would like snother copy ofthis brochure, please contact the district atthe tlephone number above. In addition o district staf, you may also contact Dr. Denise Wellnitz (OCS at __(608) 776-4021 ifyou have questions about your rights ‘Superintendent) Sincerely, Denise Welnitz Name and Title of District Contact Person